Provider Demographics
NPI:1013265420
Name:VEJCIK, WILLIAM JASON (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JASON
Last Name:VEJCIK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CENTRAL AVE UNIT 1114
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3684
Mailing Address - Country:US
Mailing Address - Phone:313-400-7875
Mailing Address - Fax:
Practice Address - Street 1:855 CENTRAL AVE UNIT 1114
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3684
Practice Address - Country:US
Practice Address - Phone:313-400-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924791041C0700X
FLSW137941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical